Basic Counselling Skills

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Basic Counselling Skills
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• The most important thing in communication is to
  hear what isn't being said. Peter Drucker

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Purpose of Presentation

• To help participants understand the concept and
  importance of counselling
• To help participants understand the process of
  counselling
• To impart the skills of counselling
• To help participants to be more aware of using
  counselling techniques appropriately and
  effectively

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Basics of Counselling

• Listening is not passive. It is important to
  indicate that the person is being heard
• Good counselling skills means listening before
  acting to solve problems

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Basics of Counselling

• Verbal listening skills
• Show interest
• Gather information
• Encourage speaker to develop ideas
• Communicate our understanding of ideas
• Request clarification of understanding
• Build the therapeutic alliance

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Listening Skills

• Using good verbal listening skills, you increase
  the chances that
• You will understand what the other is saying and
  they will understand you
• You will create a situation where you will be
  able to develop a helping relationship

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Looking Like You're Listening is Not Enough
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Listening skills

• Ask open and closed questions
• Use encouragers
• Paraphrase what you have heard
• Reflect on feeling
• Summarize

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Open Questions

• Open questions
• Generally start with what, how, why or
  could
• Questions serve to
• Gather lots of general information
• Encourage discussion

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Example Open Questions

• Nurse How has the baby been eating?
• Nurse What is the bedtime routine?
• Nurse Could you tell me about giving the baby
  medicine in the morning?

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Closed Questions

• Generally start with is, are, or do
• Serve to
• Gather lots of specific information quickly
• Tend to close down discussion

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Example Closed Questions

• Nurse Are you giving the medicine every day?
• Nurse Is the baby able to tolerate the medicine
  in the morning?

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Encouragers

• Ex Yes, I understand or repeat a word or two
  of what was said
• Serves to
• Encourage further discussion

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Example Encouragers

• Patient I missed my appointment last week
  because of transportation problems.
• Nurse Transportation problems?

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Differentiating

• Understanding whether
• Is the person is asking for information OR is the
  person is expressing concern?
• Ex Patient My baby vomited the medicine this
  morning
• Nurse Are you worried the baby is sick?

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Paraphrasing

• Briefly summarize the content of the discussion
• Reflective listening
• Check your understanding
• Show that you heard what was said
• Acknowledge and accept feelings without judging

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ExampleParaphrasing

• Patient I am worried that the medicine is
  making my baby sick
• Nurse It sounds like you are worried about how
  the baby is reacting to the medicine.

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Reflection of Feelings

• Focus on feelings (stated and unstated)
• Serves to
• Communicate understanding of emotions
• When combined with a paraphrase, confirms the
  accuracy of understanding (Check out the the
  other person)
• Encourages discussion of feelings

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Example Reflection of Feelings

• Patient I dont see many changes in the baby
  since I started the medicine
• Nurse It sounds like you are worried that the
  medicine is not helping the baby get better

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Summarizations

• Succinctly pull together ideas from a an
  interview
• Serves to
• Organize the structure of the interview
• Check the accuracy of understanding,

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Example Summarizations

• Nurse During the time we have had together we
  have talked about issues with giving the baby
  medicine, problems with transportation, and your
  worries about the baby reacting to the medicine
  and getting better. Is that right?

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Attend to Nonverbal Communication

• Increase awareness of nonverbal communications
  (yours theirs)
• Notice body language a persons stance,
  posture, physical tension
• Acknowledge what you observe be open and candid

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Example Nonverbal Communication

• Nurse You appear a little uncomfortable. Is
  there something I can do about that?
• Discussion point What other examples of
  non-verbal communication can you identify

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Non Verbal Communication

• Remember culture and context
• Most nonverbal behaviors have multiple meanings
• Some nonverbal behaviors have different meanings
  in different cultures

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A Good Listener

• Maintains eye contact
• Makes few distracting movements
• Leans forward, faces speaker
• Has an open posture
• Allows few interruptions
• Signals interest with encouragers and facial
  expressions
• What are other examples of good listening?

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Bad listening

• Makes little eye contact
• Makes distracting movements
• Faces away from speaker
• Has a closed posture (ex. arms crossed)
• Interrupts speaker
• Does too many other things while listening
• Has a flat affect, speaks in a monotone, gives
  few signals of interest
• What are other examples of a bad listener?

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Listening Practice Scenarios

• Get into a group of three people
• One person begins by talking about a troublesome
  situation. Be brief but allow your partner
  opportunities to practice listening skills.
• Listening partner Provide at least three
  different types of listening responses as your
  partner talks
• Third person is the Observer Use checklist to
  identify different listening skills
• Switch roles so that each person has a chance to
  fill each role

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Listening Practice Scenarios

• Remember the goals of listening skills
• Help the speaker feel understood
• Keep the speaker talking
• Think carefully about the thoughts and feelings
  the individual stated or implied
• Try to imagine yourself in their place in order
  to understand their message
• Make a brief verbal statement communicating what
  you heard
• No questions
• No opinions
• Check to see if you are correct

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Influencing or Changing Behavior
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Influencing or Changing Behavior

• Directives
• Reframes and interpretations
• Advice
• Feedback
• Logical consequences

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Directive

• Tells a person what to do (can be direct or
  indirect)
• Works best if clear and concrete
• Serves to
• Move a person to take a specific act

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Example Directive

• Patient I am not sure when to take my
  medicine
• Nurse You should take your medicine once in the
  morning and once in the evening

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Reframing and Interpretations

• Attempts to replace an old, maladaptive response
  with a newer, more useful (usually positive) one
• Serves to
• Increase insight and understanding
• Shift emotional or intellectual response

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Example Reframing and Interpretations

• Patient There is so much going on I dont think
  I can take my medicine
• Nurse Sometimes you feel overwhelmed and you
  are not sure that you can get everything done so
  you can take your medicine

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Advice

• Provides information to help client make a
  decision. Can be very directive or less so
• Serves to
• Share information that would be relevant for a
  persons decisions, actions, or understanding
• Disadvantages of advice
• Its often disempowering (You cant solve this on
  your own)
• People may say (but not really mean) that they
  want advice

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Example Advice

• Nurse Try stirring the medicine in milk and
  then giving it to the baby
• Nurse Let me show you how to swallow the pill
• Nurse Marking a calendar is a good idea for
  keeping track of giving medicine, and it will
  help you feel good about giving every dose

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Feedback

• Gives information about how the person is
  experienced by others
• Serves to
• Help client see self more objectively (as others
  see him or her)
• Feedback works best when
• It is requested or desired
• It is concrete
• It is positive
• If negative, it addresses something changeable or
  controllable

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Example Feedback

• Patient Last week I gave almost all of the
  doses of the medicine
• Nurse You have really worked hard to make
  improvements in giving the medicine. Lets think
  about how we can help you so that you can give
  all of the doses of medicine

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Logical Consequences

• Focuses on the logical consequences of a persons
  behavior, actions, thoughts, or feelings
• Serves to
• Increase awareness of consequences

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Example Logical Consequences

• Patient It is really hard to start the
  medicine, and the side effects are really hard
  for the baby
• Nurse If you can make it thorough the first few
  weeks of taking the medicine than the side
  effects will get better and the baby will start
  to improve

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Counselling

• The goal of counselling is to help a person tell
  their story
• With effective listening skills you can assist a
  person in communicating their thoughts and
  feelings
• When you understand where a person is starting
  from, it is easier to help them reach their goal